Method and Device for Remote Monitoring and Control of Medical Fluid Management Devices

ABSTRACT

The invention relates to the field of medical fluid management devices, in particular dialysis machines. The object of the invention is to design methods and devices, such that the monitoring and control of medical fluid management devices from a remote site are possible. To do so, the screen content of the output device of a fluid management device is transmitted at least partially to an output device of a remote control unit. The screen content optionally has user interfaces, which can be selected on the remote control device and lead to changes in the control of the transmitting medical fluid management device.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of and claims the benefitof priority under 35 U.S.C. § 120 to U.S. application Ser. No.13/549,628, filed on Jul. 16, 2012, which claims the benefit of U.S.Provisional Application No. 61/457,947, filed on Jul. 15, 2011, andGerman Application No. DE 10 2011 107 795.6, filed on Jul. 15, 2011, thecontents of which are hereby incorporated by reference.

TECHNICAL FIELD

The invention relates to a method and a device for remote monitoring andcontrol of medical fluid management devices.

BACKGROUND

Medical fluid management devices are understood here to refer inparticular to devices for conducting, treating and/or distributingliquids and/or gases in which fluid is conveyed between a patient and afluid treatment component and/or a fluid source through a fluid line.

Fluid management devices are also understood in particular to includefluid treatment devices such as blood treatment devices in which a fluidfrom a patient is sent through a fluid line to a fluid treatmentcomponent, is treated by the fluid treatment component and returned tothe patient through the fluid line which can be divided into an arterialbranch and a venous branch. Examples of such blood treatment devicesinclude in particular hemodialysis machines. One such blood treatmentdevice is the subject matter of DE 198 49 787 C1 by the presentapplicant.

Dialysis is a method for purifying the blood of patients who have acuteor chronic renal insufficiency. Essentially a distinction is made herebetween methods having an extracorporeal blood circulation such ashemodialysis, hemofiltration or hemodiafiltration (combined below underthe term hemodialysis) and peritoneal dialysis which does not involveany extracorporeal blood circulation.

In hemodialysis the blood is conveyed through the blood chamber of adialysis machine in an extracorporeal circulation, which is separatedfrom the dialysis liquid chamber by a semipermeable membrane. A dialysisfluid containing the blood electrolytes in a certain concentration flowsthrough the dialysis fluid chamber. The substance concentration of thedialysis fluid corresponds to the concentration of the blood of ahealthy patient. During the treatment the patient's blood and thedialysis fluid are passed by both sides of the membrane in general incountercurrent with a predetermined flow rate. The substances that mustbe eliminated in the urine diffuse through the membrane from the bloodchamber into the chamber for dialysis fluid while at the same timeelectrolytes present in the blood and in the dialysis fluid diffuse fromthe chamber with the higher concentration to the chamber with the lowerconcentration. If a pressure gradient is built up from the blood side tothe dialyzate side on the dialysis membrane, for example, by a pump,which withdraws dialyzate from the dialyzate circulation downstream fromthe dialysis filter on the dialyzate side, water goes from the patient'sblood through the dialysis membrane into the dialyzate circulation. Thisultrafiltration process results in the desired removal of water from thepatient's blood.

In hemofiltration, ultrafiltrate is withdrawn from the patient's bloodby applying a transmembrane pressure in the dialysis machine withoutpassing the dialysis fluid by the dialysis machine membrane on the sideof the dialysis machine membrane opposite the patient's blood. Inaddition, a sterile and pyrogen-free substituate solution may be addedto the patient's blood. Depending on whether this substituate solutionis added upstream or downstream from the dialysis machine, we speak ofpredilution or postdilution, respectively. the mass exchange takes placeby convection in hemofiltration.

Hemodiafiltration combines the methods of hemodialysis andhemofiltration. A diffuse mass exchange takes place between thepatient's blood and the dialysis fluid through the semipermeablemembrane of a dialysis machine as well as filtering of plasma waterthrough a pressure gradient on the membrane of the dialysis machine.

Plasmapheresis is a method by which the patient's blood is separatedinto the blood plasma and its corpuscular components (cells). Theseparated blood plasma is purified or replaced by a substitutionsolution and returned to the patient.

In peritoneal dialysis the abdominal cavity of a patient is filled witha dialysis fluid through a catheter guided through the abdominal wallsuch that the dialysis fluid has a concentration gradient with respectto the endogenous fluids. The toxins present in the body enter theabdominal cavity through the peritoneum which acts as a membrane. Aftera few the dialysis fluid in the patient's abdominal cavity is replaced.By osmotic processes water can be transferred from the patient's bloodthrough the peritoneum into the dialysis fluid, thereby removing thewater from the patient's body.

Dialysis methods are usually performed with the help of automaticdialysis machines such as those distributed by the applicant under thedesignation 5008 or sleep.safe.

These dialysis machines are complex medical fluid management systemswith extensive functions, the operation and monitoring of which oftenrequires specially trained personnel, in particular for hemodialysismachines.

In hemodialysis, it has become standard practice to treat patients indialysis centers, clinics or special dialysis practices, where severaldialysis machines are kept, so that several patients can be treatedsimultaneously.

Trained medical personnel is responsible for equipping the machines withthe required disposable medical articles such as tube sets, dialysisfilters and medical solutions and/or concentrates and they set themachine individually for each patient according to the doctor'sinstructions. Likewise the patient is connected to the dialysis machineand monitored constantly during dialysis by the safety equipment of thedialysis machine and by the medical personnel.

For operator input and for information output, dialysis machines areoften equipped with touchscreens. The applicant's patent DE 197 426 33 Agives an example of this.

Dialysis machines may be equipped with extensive functions formonitoring the treatment and the patient. For example, the pressure inthe arterial blood tube carrying blood from the patient to the dialysismachine can be monitored. An excessive drop in the arterial bloodpressure may indicate that the arterial needle has been disconnected,for example, or it may indicate that the arterial needle is applyingsuction to the patient's vascular wall. Either case justifies alarmingthe medical personnel which must then perform additional steps.

However, situations may also occur with machines for automaticperitoneal dialysis which is often performed at the patient's home butnot necessarily, but such situations may necessitate an operatorintervention by a skilled person such as a dialysis nurse or a dialysisphysician.

If the dialysis machine is at the patient's home, as is often the casein peritoneal dialysis, manual intervention by medical personnel isimpossible.

In a dialysis practice or in a dialysis clinic, several dialysismachines are usually located in one room and there are often multipledialysis machines in different rooms which are at a distance from oneanother or may even be distributed over various floors.

An alarm state is often signaled acoustically and optically by adialysis machine to draw the attention of the medical personnel to acorresponding incident, for example, in the style of a traffic light.

Independently of this however, alarm states are often signaledacoustically by alarm tones or alarm tone sequences which must have aprescribed loudness in order for the medical personnel to be reliablyalerted.

Such acoustic alarms are therefore also heard by other patients who arebeing treated in the same room, which may be perceived as annoying. Thedialysis treatment usually lasts for several hours. The patient's oftensleep during the dialysis treatment so that an acoustic alarm alsocauses the patient to be awakened. Therefore the European standard forelectrical medical devices DIN EN 60601-2-16 stipulates the possibilityof a remote alarm for the medical personnel by having the alarminitially output only at a remote device.

If an alarm state occurs, the medical personnel must move to the machinesending out the alarm in order to evaluate the cause of the alarm andeliminate it. The medical personnel must also approach the patient andthe dialysis machine for regularly checking on the machine and thepatient's well-being. The medical personnel is often also summoned bythe patient himself when he has a concern.

In daily dialysis practice this means relatively great distances for themedical personnel and increased agitation in the treatment rooms, whichshould be avoided from the standpoint of comfort and for therapeuticreasons.

In addition, it may happen that a medical intervention in the control ofthe dialysis machine is necessary. However, physicians are notnecessarily constantly present in spatial proximity to the patients. Insuch a case valuable time may elapse under some circumstances before amedical intervention is performed.

SUMMARY

The object of the present invention is to design methods and devices sothat the monitoring and control of medical fluid management equipmentare possible from a remote location and their safety and operatingconvenience are increased.

These objects are achieved according to the invention by a method havingthe features of Claim 1 and by a device having the features of Claim 21.

Advantageous embodiments are the subject matter of the subclaims.

The invention is based on a method for remote monitoring and control ofmedical fluid management devices having at least one input and outputdevice, preferably a touchscreen display, where at least parts of theinformation content of the at least one input and output device of themedical fluid management equipment are to be transferred to at least oneremote control unit and output, and operator input can be entered on atleast one input and output device of the remote control unit preferablya touchscreen, controlling a medical fluid management device.

In addition, the invention is based on a medical fluid management devicehaving at least one input and output device, preferably a touchscreendisplay and a remote control unit having at least one input and outputdevice, preferably a touchscreen display, where the medical fluidmanagement device is equipped to transfer at least parts of theinformation content of the at least one input and output device of themedical fluid management device to at least one remote control unit, andthe remote control unit is equipped to display the information contenttransferred from the medical fluid management device to the at least oneinput and output device and to transfer operator input at the at leastone input and output device to the medical fluid management device.

A dialysis machine which may be embodied as a hemodialysis machine or asa device for automatic peritoneal dialysis is described below asrepresentative of a medical fluid management device. It will be clear tothose skilled in the art that the invention can readily be applied toany medical fluid management device.

Dialysis machines are often equipped with touchscreen user interfaces,which serve as input and output devices. Technical medical equipmentfurnished with touchscreens provide the operator with a comfortable,variable user interface which is also hygienic due to the flat anuninterrupted surface.

Variable image contents can be displayed on the touchscreen throughsoftware control. Thus the settings of the dialysis machines, forexample, the dialysis fluid flow rate or the elapsed dialysis time canbe displayed on the touchscreen. Current measured values, for example,the arterial and venous pressure in the access tubes can also bedisplayed. By touching the touchscreen at operator areas, operator inputfor the dialysis machine can be made to alter the settings of thedialysis machine, for example, or to respond to an alarm appropriately.

According to the invention the image content of the dialysis machine istransferred to a remote control unit. This transfer may take place by ahard-wired connection, e.g., via a local area network (LAN) orwirelessly, for example, by radio (WLAN, Bluetooth) or by opticaltransmission, for example, by infrared interface.

The remote control unit is preferably also equipped with a touchscreenbut in any case with a display screen and an input device such as akeyboard and/or a computer mouse.

The image content transferred from the dialysis machine is output on theoutput device on the remote control unit. Thus there is a one-to-oneimage of image content of the touchscreen of the dialysis machinesending the information. If the input and output device of the remotecontrol unit is designed as a touchscreen, then operator input on thecontrol unit may be done here like operator input on the dialysismachine. There is then no difference in operation between the dialysismachine and the remote control unit.

However, the remote control unit may also be designed without atouchscreen, for example, as a notebook with a touchpad or a connectedcomputer mouse. The software of the remote control unit in this case isprogrammed so that operator input can be implemented via the keyboardand/or via the touchpad and/or via the computer mouse. For example,numerical entries which may be entered by finger pressure on thetouchscreen on the dialysis machine via a numerical keypad which isdisplayed and may be entered conveniently and rapidly by keyboard on anotebook.

The remote control unit may also be a smartphone or a tablet PC inparticular a mobile computer which may be carried by physicians or othermedical personnel.

For all embodiments of the remote control unit it is essential that theoperator input on user interfaces of the screen content sent by thesending dialysis machine is transmitted to the input and output deviceof the remote control unit on each dialysis machine which sent thescreen contents where they manifest the same effect as if they had beeninput on this dialysis machine.

The monitoring and control of dialysis machines from a remote controlunit is possible in real time in this way, and in a particularlyadvantageous manner it is possible from any location within the range ofthe network over which the dialysis machines and the remote control unitcommunicate with one another.

If this communication takes place not only between a dialysis machineand a remote control unit but also between a dialysis machine andmultiple remote control units, then prioritization of the operator inputat the remote control units may be performed by assigning a priority tothe remote control units based on the qualification of the operator.

For example, a lower priority may be assigned to a remote control unitwhich is near a nurse's room than to a remote control unit operated by adialysis physician. Operator input from a remote control unit of a highpriority is then executed preferentially in comparison with operatorinput from a remote control unit of a lower priority.

For example, if the dialysis physician has stopped a dialysis treatmentby means of a remote control unit which can be assigned to him, then adialysis nurse cannot readily resume this treatment via an operatorinput on a remote control unit which may be assigned to her.

The assignment of the remote control units may be done, for example, vianetwork address or device-specific hardware address (MAC address) andstored allocation tables or by using a PKI system (PKI, English forpublic key infrastructure) which can issue, distribute and verifydigital certificates. Alternatively or additionally the operatingpersonnel at the remote control unit may provide authentication in asuitable manner, for example, by entering a personal user name andpassword combination (personal alphanumeric code) or by entering thefingerprint via a fingerprint sensor or by entering an eye iris scan.

It is possible in this way to be sure that only authorized persons areallowed to operate the dialysis machine and that operator input bypeople of a higher professional competence than people of a lowerprofessional competence is executed in a preferential manner.

Another embodiment of the invention provides that in addition totransmitting the information content of the at least one input andoutput device of a dialysis machine, video and audio signals can also beexchanged by people.

To this end, at least the dialysis machines, preferably also the remotecontrol units, are equipped with a camera and/or a loudspeaker and/or amicrophone.

The camera on the dialysis machine is preferably aimed at the dialysispatient. In case of need the instantaneous image of the patient istransmitted to the remote control unit where it is displayed. In thisway the medical personnel can see the respective patient.

The remote control unit may also be equipped with a camera and/or aloudspeaker and/or a microphone to display the image of the medicalpersonnel on the display screen of a dialysis machine and/or to enableverbal communication.

The camera images are preferably displayed on partial areas of theoutput devices.

Visual or verbal and/or acoustic communication may be initiated here bythe dialysis machine as well as by the remote control unit in that acorresponding operating measure is performed on the device itself or onan external device connected to the dialysis machine, such as a remotecontrol or a patient interface.

The patient and physician and/or medical personnel can speak to oneanother in this way and can both see the respective display screen. Forexample, dialysis patients can inform the medical personnel of theirneeds without having to wait for the medical personnel to come closeenough to call. Conversely, the medical personnel can speak to apatient, for example, to ask him how he is doing without having to movehim.

This means a great relief in terms of labor and eliminates unnecessarydistances in a treatment ward, which makes a significant contributiontoward restfulness and comfort in the treatment ward.

There can be communication through a camera, a microphone and aloudspeaker not only between medical personnel and the patient orlimited to two participants. For example, communication among patientsthemselves is also conceivable. It may happen during the work sequenceof a dialysis ward that patients who have become friends and are treatedat the same time are treated at dialysis machines located a greatdistance apart from one another.

Due to the inventive embodiment of the dialysis machines with camera,loudspeaker and microphone, the patients can also communicate with oneanother. For such communication it is advantageous if the dialysismachines are additionally equipped with a mobile portable patientinterface which is reserved for the dialysis patient. Such a patientinterface may be, for example, a notebook or a tablet PC which ispreferably connected wirelessly to the dialysis machine or to a remoteserver for technical data transmission and can be unambiguously assignedto the treatment site. The output device of the mobile portable patientinterface is preferably a touchscreen.

The mobile patient interface may also be equipped with a camera and/orloudspeaker and/or microphone. The dialysis machine is usually set up sothat the output device can be read conveniently by the medicalpersonnel. This often means that the patient being treated has little orno view of the output device of the dialysis machine. The information onthe output device of the dialysis machine is often of no interest forthe patient.

If the patient interface is defined as a portable device, the patientcan hold the patient interface conveniently during dialysis so that theoutput device is readily readable. The image content of the outputdevice of the patient interface may be independent of the image contentof the output device of the dialysis machine. Thus, for example,multimedia contents such as movies or images may be displayed, but a webbrowser enabling access to the Internet is also conceivable. The patientis thus entertained and informed individually during the dialysistreatment. So as not to interfere with other patients in a dialysisward, the patient interface may be equipped with headphones.

For communication between patients, special software may be provided,listing all the patients participating in the patient-to-patientcommunication somewhat like an exchange. It is conceivable for aselection window on which the patient can establish a connection for thepurpose of communication with other patients by user input throughappropriate user input on a patient interface.

Another inventive embodiment provides that the remote control unit is asmartphone which the medical personnel in particular a physician carrieswith him. Smartphones are characterized by their expanded computerfunctionality in comparison with normal mobile telephones. This may bemanifested, for example, in a high resolution display, preferably with atouchscreen functionality. The operating systems of smartphones areusually designed so that a variety of program so-called apps can beexecuted. Smartphone devices are understood to include all moderndevices having a computer functionality in the sense of the inventionbut not being computers in the sense of laptops or notebooks, forexample, even so-called tablet PCs.

Smartphones usually exchange data over the mobile communications networkas well as over local radio networks (WLAN, Bluetooth). A physiciancarrying such a smartphone can have access to a certain display unitfrom anywhere in the manner described above. Smartphones are usuallyalso equipped with a camera so that direct communication with imagetransmission in the manner described here is also possible with thisembodiment.

This embodiment is especially advantageous in patients who undergoso-called hemodialysis, for example, in peritoneal dialysis or withhemodialysis machines for home use. In such cases, the patient performsthe dialysis at home and usually there is no medical personnel on hand.However, then situations in which expert intervention in the control ofthe device may be necessary may occur. According to the invention suchan intervention may be performed now by the medical personnel via theremote control which may be a smartphone. In addition, communication inthe manner already described may also take place via the mobilecommunications network or via the Internet.

It is essential for the security of the remote control of a dialysismachine that there is no faulty transmission of image data from thedialysis machine to the remote control unit and/or faulty transmissionof operator input from the remote control unit to the dialysis machine.

Extensive safety measures are taken in this regard. It is provided thatthe image content of a dialysis machine is periodically transferred tothe remote control unit. Thus there is a periodic screen update. Inaddition, screen updates may be performed when the image contentchanges, for example, when a measured value displayed on the displayscreen of the dialysis machine changes.

To be sure that the image transmitted to the remote control unit has thesame content as that on the dialysis machine, a CRC (cyclic redundancycheck) of the screen content may also be calculated and transmitted witheach screen update. The cyclic redundancy check (CRC) is a method fordetermining a check value for data to be able to detect errors in thetransmission or storage. In the remote control unit, a CRC may also becalculated for the received screen content and compared with thereceived CRC data. In an error-free transmission, the two CRC data donot differ. If a difference is found between the CRC data transmitted bythe dialysis machine and the CRC data calculated by the remote controlunit, then there is obviously a transmission error. The remote controlunit may then request a new transmission of the corresponding dialysismachine. If the transmission is still faulty, the remote control unitcan output (optically, acoustically or haptically) an error messagesignal, which should prompt the medical personnel to check therespective dialysis machine.

In addition to transmission of the image content together with the datafrom a CRC, a time stamp may also be transmitted, providing informationabout the time of day to be assigned to the transmitted image content.On receiving a new image content, the remote control unit compares thenew image content having the transmitted time stamp with the lastreceived time stamp and the current time. Due to the intended periodictransmission at equidistant time intervals in normal operation, theremote control unit can determine whether the transmission receivedcurrently is what was expected in comparison with the transmissionreceived last or whether the current transmission has arrived too soon,which would indicate a change in the screen content, for example, achange in a measured value which takes place before the normal screenupdate. Such transmissions can be treated in a particular manner; forexample, the change in comparison with the last transmitted screencontent can be identified separately, for example, by graphic emphasissuch as an arrow, color emphasis, flashing or being displayed in aseparate area of the output device of the remote control unit.

In the same way, the remote control unit can ascertain that an expectedtransmission has failed to occur. In this case the remote control unitmay request a screen update from the dialysis machine in question viathe network. If this screen update fails to occur, there may be an errormessage prompting the medical personnel to check the dialysis machineand to order additional steps if necessary.

It is equally essential to ensure that the remote control unit isoperating properly and also displays the screen content transmitted by adialysis machine properly. To do so the remote control unit may send aconfirmation message to the respective dialysis machine on properlyreceiving a transmission, and this message may also be provided with atime stamp. If this confirmation message does not arrive or if itarrives late, this indicates problems in transmission and the dialysismachine can report corresponding error messages and/or alarm signals.Safety is further increased by the mutual checking of the transmission.

It is also essential to ensure that operator input on the remote controlunit is transmitted in error-free form to the dialysis machine. This maybe achieved by the fact that the dialysis machine sends a receivedoperator input from a remote control unit back to the remote controlunit before executing an action associated with the operator input suchthat a comparison is performed there of whether the operator input sentand that received again match one another. Depending on this comparison,a signal is sent from the remote control unit to the dialysis machineand either enables or blocks the action associated with the operatorinput. After executing the action associated with the operator input,the dialysis machine may send a confirmation signal to the remotecontrol unit, indicating that the action has been performed. If thereare deviations from what is expected in this sequence at any point, analarm signal (acoustic, optical or haptic) is output at the remotecontrol unit and/or on the dialysis machine. The medical personnel maythen check the equipment, eliminate the cause of error and acknowledgethe alarm.

In all possible exemplary embodiments, such data transmission protocolswhich are reliable with regard to confidentiality, authenticity andintegrity are preferred for the transmission of data and include, forexample, the Internet protocol security (IPSec) or virtual privatenetwork (VPN, OpenVPN) as the data transmission protocols.

In addition, a data transmission protocol with secure identification ofthe exchanging devices, such as Bluetooth or infrared (IRDA “infrareddata association) can be used for authentication of the dialysis machineto be operated and of the remote control unit.

It is possible to provide that unique identification features of thecommunicating devices, such as MAC addresses or device identificationnumbers are exchanged in the initial contact between the dialysismachine to be operated and the remote control unit. These identificationfeatures may be linked to different legitimations. The data transmissionmay be allowed, blocked or restricted, depending on the legitimation.This procedure ensures that information is transmitted from the dialysismachine only to authorized persons.

Due to the secure identification of the dialysis machine to be operatedand of the remote control unit, a single remote control unit may be usedto operate multiple different dialysis machines in a simple method. Thisensures that the operator at the remote control unit of the dialysismachine to be operated will be identified unambiguously, for example, bydisplay of a device identification number.

To save energy with the dialysis machine, its touchscreen display may beswitched off or operated at a reduced brightness. Only in the event ofoperation or when there is an alarm message is it possible to providefor the display to be operated in normal mode. The operability of thedialysis machine and the feasibility of providing information can bepreserved by the inventive data transmission to a remote control unit.In a dialysis ward having a plurality of dialysis machines, a great dealof energy can be saved in this way, and this has a positive effect onthe operating costs.

In all exemplary embodiments it is possible to provide that in the caseof a terminated connection between the dialysis machine and the remotecontrol unit or in the case of a defective connection the dialysismachine automatically goes into a secure operating state so as toincrease safety and not endanger the patient. Such a safe state is, forexample, [achieved by clamping off the extracorporeal blood circulationfrom the vascular system of the patient by using corresponding clamps onthe arterial and venous accesses of the patient and by completelystopping the blood pump.

Another embodiment of the invention provides for alarm states whichdetect a dialysis machine are first transmitted to the remote controlunit without leading to a direct output of an optical, acoustic orhaptic alarm signal on the dialysis machine. Dialysis machines a usuallyequipped with a number of monitoring devices which monitor the dialysistreatment and send out alarm signals in an error case. These alarmsignals may be optical, acoustic and haptic. It is essential for thealarm signals that they are noticed by the medical personnel. However,when sending out an alarm signal in a dialysis center, not only is themedical personnel alerted but also the patients who are present aredisturbed by the alarm signal. To avoid this disturbance, the inventionprovides for an alarm state that occurs to first be signaled on theremote control unit.

The medical personnel that must approach the respective dialysis machineto eliminate the cause of the alarm is therefore alerted first. Then themedical personnel can subsequently acknowledge the alarm on the dialysismachine. It is possible to provide that the dialysis machine respondsitself to a lack of acknowledgment of the alarm by delayed signaling ofthe alarm to the dialysis machine.

BRIEF DESCRIPTION OF THE FIGURES

Additional details and advantages of the invention will now be describedin greater detail on the basis of the exemplary embodiments shown in thedrawings, in which:

FIG. 1 shows a dialysis ward having equipment according to the inventionfor remote monitoring and control of dialysis machines;

FIG. 2 shows a first embodiment of the screen content of an inventiveremote control unit for remote monitoring and control of dialysismachines;

FIG. 3 shows another embodiment of the screen content of an inventiveremote control unit for remote monitoring and control of dialysismachines and

FIG. 4 shows an inventive remote control unit designed as a smartphonefor remote monitoring and control of dialysis machines.

DETAILED DESCRIPTION

FIG. 1 shows a typical dialysis ward with a treatment room 101 and amonitoring room 120 which may be located a distance apart from oneanother. Three treatment wards 102, 103, 104 each comprising dialysismachines 105, 106, 107 and patient seating equipment 108, 109, 110, heredesigned as a couch are provided in treatment room 101. The dialysismachines 105, 106, 107 are each equipped with an output device 105 a,106 a, 107 a, which are embodied here as a touchscreen as an example.

In monitoring room 120 a remote control unit, embodied here as astationary computer 121 with a touchscreen 122 is provided. In themonitoring room the medical personnel has the option to monitor apatient's dialysis treatment in the remote treatment room 101 and/or toinfluence the control of the machine. In FIG. 1 concentric circles 1 1 1indicate how the dialysis machine sends data to the remote control unit121 by radio, for example, over a secured WLAN connection. The remotecontrol unit may then display the screen content or parts thereof on itsoutput device 122. In addition, the user interfaces of the dialysismachine 105 sending the content are displayed on the touchscreen 122.The medical personnel can operate the transmitting dialysis machine bydepressing these user interfaces in the same way as if the operatorinput were being made on a touchscreen 105 a. The remote control unit121 therefore communicates in the manner already described with thedialysis machine 105, which converts the operator input on the remotecontrol unit.

The dialysis machines 105, 106, 107 may be equipped with a camera and amicrophone in the manner already described (not shown in FIG. 1). Thecamera is preferably movably mounted on the dialysis machine or on apatient interface which interacts with the dialysis machine so that itcan be aligned with the patient. Alternatively, however, one or moremovable cameras may also be mounted, for example, on the ceiling of thetreatment room 101, which can be directed at a patient by control. It isessential that cameras with which the image of a certain patient can besent to the remote control unit can be provided.

FIG. 2 shows an example of the screen content of a dialysis machine onthe output device of a remote control unit.

The screen display consists of the information in a display region 201,indicating which dialysis machine (dialysis machine 5008 in FIG. 2) inwhich treatment room (ward 1) with which patient (Max Mustermann) isbeing monitored and controlled by the remote control unit at thismoment. Display region 201 shows the current image 202 and 203 of themedical personnel at the remote control unit and the patient at therespective dialysis machine. An audio-visual connection between themedical personnel and the patient can be established by pressing withthe finger on operator input 204 (CALL). This is done in the manneralready described using cameras, loudspeaker and microphones on thedialysis machine and on the remote control unit.

Among the images of the medical personnel and the patient, thetransmitted one-to-one image 205 of the screen content of the dialysismachine is displayed. This display can also be seen at the same time onthe output device of the respective dialysis machine. This is thedisplay of an alarm state namely the alarm indicating that the arterialpressure has dropped below a cutoff limit. The alarm message appears ina special region 205 a of the display region 205. The medical personnelhas the option of either resetting the alarm (indicated by the userinterface “Reset alarm” in FIG. 2) or entering a new lower limit for thearterial pressure (represented by the user interface “Set new alarmlimits” in FIG. 2). In the same way any operator input for a certaindialysis machine even those not preceded by an alarm message can be madeon the remote control unit.

Furthermore an additional acoustic, optical or haptic alarm signal mayalso be output on the remote control unit to alert the medicalpersonnel. This alarm signal may be suppressed on the respectivedialysis machine in order not to disturb the respective patient orinterfere with patients being treated in the same room.

It may happen that certain situations occur in which the medicalpersonnel must approach a certain dialysis machine. Examples of thismight be when the patient has a concern or when manual procedures arerequired on the machine, for example, disconnecting the patient from thedialysis machine.

FIG. 3 shows how the remote monitoring and remote control of multipledialysis machines within one dialysis ward are facilitated according tothe invention. The right part 301 of FIG. 3 corresponds to the displayas shown in FIG. 2. In addition, a layout of the dialysis ward is shownin the left part of FIG. 3. This gives the medical personnel an overviewof how the ward is currently occupied by which patients, on whichdialysis machine these patients are being treated, where these dialysismachines are located in the dialysis ward and the status of thetreatment currently. The entire FIG. 3 is an example of a screen displayon a remote control unit, for example, on a large monitor with atouchscreen functionality in a monitoring room of a dialysis ward.

FIG. 3 shows a view illustrating where the dialysis machines 302 to 308are located and whether these machines are currently in use. To do sothe dialysis machines with patient accommodating furnishings are shownin a layout diagram of the dialysis ward. If a patient is currentlybeing treated on a certain dialysis machine, his name may appear in adisplay area (309, 310, 311) inside the patient accommodatingfurnishings, as symbolized here. Likewise the progress of the dialysistreatment can also be displayed. In FIG. 3 this is accomplished throughbar displays 312, 313, 314 each showing the percentage of elapseddialysis time in relation to the total dialysis time but other forms ofrepresentation are also conceivable.

Checkmarks 315, 316 are displayed in the respective symbolic dialysismachine in FIG. 3 when the treatment is proceeding within normalparameters or alarm symbols 317 appear when a problem occurs. Any othercharacters and displays are also conceivable. It is important only thatit is signaled unambiguously to the observer whether a certain dialysismachine is currently posing a problem or whether the treatment isproceeding currently without any problem on a certain dialysis machine.

The arrow shown with an interrupted line in FIG. 3 having its origin inthe monitoring room 318 and pointing to dialysis machine 302 indicatesclearly to the medical personnel to which dialysis machine they mustmove in case of need. Moreover the arrow implements a type of pointerwhich makes it easier for the personnel in a large dialysis ward havinga plurality of treatment sites to find a specific dialysis machine. Anygraphical displays are conceivable for representing the pointer.

It is conceivable that the personnel additionally has a display on aportable device as shown in FIG. 4. The path to a certain dialysis wardmay be represented on such a device as a function of the position of themedical personnel, much like with a navigation unit. The device thusgives the observer instructions in the form of arrows, for example,and/or acoustic directional information indicating where the observershould go to reach a specific dialysis machine. The medical personnelwould thus be directed to a patient on the shortest possible path.

It is also conceivable that such a pointer may be displayed on portabledevices for medical personnel who are not involved with the dialysistreatment but instead perhaps must perform medical actions on a certaindialysis patient because of another indication during a dialysistreatment. Thus, for example, in the case of a pregnant dialysispatient, an obstetrician/gynecologist may be called in case of need inwhich case the latter could become oriented rapidly on the basis of thepointer being displayed on a portable device such as a smartphone andcan reach the patient promptly and reliably. The position determinationon the remote control unit may be accomplished through methods familiarwith navigation systems, for example, by using a GPS-based positiondetermination. However, it is also conceivable to analyze the signalstrengths of mobile radio or WLAN transmitters.

FIG. 4 illustrates an exemplary embodiment of a portable remote controlunit 401 which is designed as a smartphone. The display 402 on aportable remote control unit does not differ fundamentally from thedisplays on the output devices of a stationary remote control unit. Theimplementation as a smartphone, however, makes it possible for medicalpersonnel to be involved in the monitoring and control of dialysismachines even if they are not within walking distance from the dialysismachines. It is conceivable that hemodialysis patients, for example, maybe monitored by medical personnel via a remote control unit in this way.It does not matter here which type of dialysis the patient is undergoingat home.

It is also conceivable that a dialysis physician, for example, might beequipped with such a portable control unit and be able to participate inthe monitoring and control of dialysis machines by mobile communicationsnetwork. Such mobile control units are often equipped with a camera asshown by camera lens 403 in FIG. 4. Equipment with a loudspeaker and amicrophone is standard with smartphones anyway but also with tablet PCsas another example of a portable remote control unit are usuallyequipped with a camera, microphone and loudspeaker. Smartphones andtablet PCs are usually equipped with touchscreens. However, it is alsoconceivable for the remote mobile control unit to be a laptop, notebookor netbook with a keyboard which may be equipped with a touchpad and/ora computer mouse.

Due to the mobility of the remote control unit in the embodiment shownin FIG. 4, the medical personnel can be contacted at any time and anyplace. It is conceivable that the normal attending medical personnelwill preferably remain within walking distance of the patient inmonitoring the dialyzes but dialysis physicians need not necessarily bepresent in walking distance from the patient. In case of need the adviceof a specialist, preferably a dialysis physician and/or nephrologist maybe obtained in this way. The specialist may be anywhere in the worldwithin range of a supported mobile communications network or may use anInternet connection.

Extensive options for control of the dialysis machines are available tothe specialist through transmission of the screen content and the userinterfaces. It is conceivable that contacting a specialist is initiatedindependently by a mobile remote control unit of the dialysis machine.This may occur, for example, in certain alarm situations or with certainpatients who require special attention, for example, because of aspecial medical indication. However, contact of a specialist may alsoequally be done by the medical personnel.

The present invention describes methods and devices which make thesequences within a dialysis ward or in home dialysis safer, moreconvenient and simpler. It is clear to those skilled in the art that themethods described here can be applied not only to dialysis but alsoanywhere that medical technical equipment and attending personnel caninteract at a distance from one another.

The invention relates to the following aspects:

1. A method for remote monitoring and control of medical fluidmanagement equipment having at least one input and output device,preferably a touchscreen display characterized in that a datatransmission takes place in which at least parts of the informationcontent of the at least one input and output device of a medical fluidmanagement device are transmitted and output to at least one remotecontrol unit, and the operator entries can be input on at least oneinput and output device of the at least one remote control unit,preferably a touchscreen, controlling the medical fluid managementdevice.

2. The method according to aspect 1, characterized in that thetransmission of at least parts of the information content of the atleast one input and output device of a medical fluid management deviceto at least one remote control unit takes place periodically.

3. The method according to aspect 1, characterized in that thetransmission of at least parts of the information content of the atleast one input and output device of a medical fluid management deviceto at least one remote control unit takes place immediately when theinformation content of the at least one input and output device of themedical fluid management device changes.

4. The method according to any one of the preceding aspects,characterized in that the change in the transmitted information contentof the at least one input and output device of the medical fluidmanagement device to the at least one input and output device of the atleast one remote control unit is emphasized graphically.

5. The method according to any one of the preceding aspects,characterized in that the data transmission is provided with a timestamp, which is also transmitted.

6. The method according to any one of the preceding aspects,characterized in that a CRC check ensures that the transmission of theinformation content of the at least one input and output device to aremote control unit has taken place without error.

7. The method according to any one of the preceding aspects,characterized in that the data transmission between the medical fluidmanagement device and the remote control unit takes place over a securedata transmission protocol.

8. The method according to any one of the preceding aspects,characterized in that the medical fluid management device automaticallyassumes a secure state when termination of a connection between thefluid management device and a remote control unit is detected.

9. The method according to any one of the preceding aspects,characterized in that the medical fluid management device is a bloodtreatment device.

10. The method according to aspect 9, characterized in that the bloodtreatment device is equipped for hemodialysis, for hemofiltration, forhemodiafiltration, for plasmapheresis or for automatic peritonealdialysis.

11. The method according to any one of the preceding aspects,characterized in that the remote control unit is a stationary computer.

12. The method according to any one of the preceding aspects,characterized in that the remote control unit is a tablet PC.

13. The method according to any one of the preceding aspects,characterized in that the remote control unit is a smartphone.

14. The method according to any one of the preceding aspects,characterized in that the medical fluid management device and/or theremote control unit are equipped with a camera and a loudspeaker and amicrophone, at least one camera image and at least one microphone signalbeing generated.

15. The method according to aspect 14, characterized in that a cameraimage and a microphone signal are transmitted from the medical fluidmanagement device to the remote control unit and/or vice versa.

16. The method according to aspect 14, characterized in that cameraimages and microphone signals from at least two medical fluid managementdevices are exchanged between at least two medical fluid managementdevices.

17. The method according to any one of aspects 14 through 16,characterized in that a camera image transmitted to a medical fluidmanagement device is displayed on a mobile patient interface.

18. The method according to any one aspects 14 through 17, characterizedin that the camera image is displayed on a partial area of an outputdevice.

19. The method according to any one of the preceding aspects,characterized in that an alarm state is transmitted from the medicalfluid management device to a remote control unit and is output as anacoustic, optical or haptic alarm, at first on only the remote controlunit.

20. The method according to any one of the preceding aspects,characterized in that operator input at the remote control unit receivesa priority and is transmitted to the medical fluid.

21. The method according to aspect 20, characterized in that theoperator input of a high priority is executed preferentially on themedical fluid management device in comparison with operator input of alower priority.

22. The method according to any one of the preceding aspects,characterized in that the operating persons are authenticated on theremote control unit.

23. The method according to aspect 22, characterized in that theauthentication of the operator is down by manual input of a personalalphanumeric code or by input of a fingerprint or by entering an opticaliris scan.

24. The method according to any one of the preceding aspects,characterized in that a floor plan of medical fluid management devicesof a treatment ward is displayed on the output device.

25. The method according to aspect 24, characterized in that the pathfrom the remote control unit to a medical fluid management device isdisplayed graphically in the floor plan.

26. The method according to any one of the preceding aspects,characterized in that direction instructions indicating the path fromthe remote control unit to a medical fluid management device aredisplayed on the output device of the remote control unit.

27. A system comprising a medical fluid management device having atleast one input and output device, preferably a touchscreen display andat least one remote control unit having at least one input and outputdevice, preferably a touchscreen display, characterized in that themedical fluid management device and the remote control unit are equippedto transmit data, such that at least parts of the information content ofthe at least one input and output device of the medical fluid managementdevices are transmitted to at least one remote control unit,

and the remote control unit is equipped to display the informationcontent transmitted from the medical fluid management device on the atleast one input and output device and to transmit operator input on theat least one input and output device to the medical fluid managementdevice.

28. The device according to aspect 27, characterized in that the medicalfluid management device and the remote control unit are equipped totransmit at least parts of the information content of the at least oneinput and output device of the medical fluid management device to atleast one remote control unit periodically.

29. The device according to aspect 27, characterized in that the medicalfluid management device and the remote control unit are equipped totransmit at least parts of the information content of the at least oneinput and output device of the medical fluid management device to atleast one remote control unit immediately when the information contentof the at least one input and output device of the medical fluidmanagement device changes.

30. The device according to any one of aspects 27 to 29, characterizedin that the medical fluid management device and the remote control unitare equipped to graphically emphasize a change in the transmittedinformation content of the at least one input and output device of themedical fluid management device on the at least one input and outputdevice of the at least one remote control unit.

31. The device according to any one of aspects 27 to 30, characterizedin that the medical fluid management device and the remote control unitare equipped to provide a time stamp for the data transmission.

32. The device according to any one of aspects 27 to 31, characterizedin that the medical fluid management device and the remote control unitare equipped to perform a CRC check to ensure that the transmission ofthe information content of the at least one input and output device to aremote control unit has occurred without error.

33. The device according to any one of aspects 27 to 32, characterizedin that the medical fluid management device and the remote control unitare equipped to have the data transmission between the medical fluidmanagement device and the remote control unit take place via a securedata transmission protocol.

34. The device according to any one of aspects 27 to 33, characterizedin that the medical fluid management device is equipped to automaticallyassume a secure state when termination of a connection between the fluidmanagement device and the remote control unit is detected.

35. The device according to any one of aspects 27 to 34, characterizedin that the medical fluid management device is a blood treatment device.

36. The device according to aspect 35, characterized in that the bloodtreatment device is equipped for hemodialysis, for hemofiltration, forhemodiafiltration, for plasmapheresis and/or automatic peritonealdialysis.

37. The device according to any one of aspects 27 to 36, characterizedin that the remote control unit is a stationary computer.

38. The device according to any one of aspects 27 to 37, characterizedin that the remote control unit is a tablet PC.

39. The device according to any one of aspects 27 to 38, characterizedin that the remote control unit is a smartphone.

40. The device according to any one of aspects 27 to 39, characterizedin that the medical fluid management device and/or the remote controlunit is/are equipped with a camera and a loudspeaker and a microphone,at least one camera image and at least one microphone signal beinggenerated.

41. The device according to aspect 40, characterized in that the medicalfluid management device and the remote control unit are equipped totransmit a camera image and a microphone signal from the medical fluidmanagement device to the remote control unit and/or vice versa.

42. The device according to any one of aspects 40 to 41, characterizedin that the medical fluid management device is equipped to receive acamera image and a microphone signal from at least one additionalmedical fluid management device.

43. The device according to any one of aspects 40 to 42, characterizedin that it comprises a mobile patient interface equipped to display acamera image.

44. The device according to any one of aspects 40 to 43, characterizedin that the medical fluid management device and/or the remote controlunit is/are equipped to display a camera image on a partial area of anoutput device.

45. The device according to any one of aspects 27 to 44, characterizedin that the medical fluid management device is equipped to transmit analarm state to a remote control unit and to suppress the output of anacoustic, optical or haptic alarm temporarily.

46. The device according to any one of aspects 27 to 45, characterizedin that the remote control unit is equipped to provide operator inputwith a priority and to transmit the operator input to a medical fluidmanagement device.

47. The device according to aspect 46, characterized in that the medicalfluid management device is equipped to execute operator input of a highpriority preferentially in comparison with operator input of a lowerpriority.

48. The device according to any one of aspects 27 to 47, characterizedin that the remote control unit is equipped so that the operatingpersons on the remote control unit authenticate themselves.

49. The device according to aspect 48, characterized in that the remotecontrol unit is equipped to enable the authentication by manual input byan operator of a personal alphanumeric code or by entering a fingerprintof the operator or by entering an optical iris scan.

50. The device according to any one of aspects 27 to 49, characterizedin that the remote control unit is equipped to display a floor plan ofmedical fluid management devices of a treatment ward on the outputdevice of the remote control unit.

51. The device according to aspect 50, characterized in that remotecontrol unit is equipped to display graphically the path from the remotecontrol unit to the medical fluid management device in the floor plan.

52. The device according to any one of aspects 27 to 51, characterizedin that the remote control unit is equipped to display directioninstructions on the output device of the remote control unit, showingthe path from the remote control unit to the medical fluid managementdevice.

53. The medical fluid management device implemented with the features ofat least one of aspects 27 to 52.

54. The control unit implemented with the features of at least one ofaspects 27 to 52.

What is claimed is: 1-20. (canceled)
 21. A medical system comprising: amedical device comprising a display device; and a first remote deviceconfigured to: communicate with the medical device to determine atreatment state of a medical treatment that the medical device iscurrently providing, receive, from the medical device, one or moreimages of at least a portion of a screen content presented on a displaydevice of the medical device, the portion of the screen contentincluding an alarm indicator indicating a state of an alarm on themedical device, display on a user interface of the first remote device(i) the one or more images of the screen content of the medical device,and (ii) the treatment state of the medical device, and transmit, to themedical device, first data that influences control of the medicaldevice, wherein the first data comprises command signals for alteringthe state of the alarm of the medical device and command signals forceasing a dialysis treatment.
 22. The medical system of claim 21,wherein the medical device is configured to: receive, from the firstremote device, the first data; receive, form a second remote device,second data that influences the medical device, the second remote devicebeing remote from the medical device; determine a first priorityassigned to the first remote device, and a second priority assigned tothe second device; and perform operations based on the first data and inaccordance with the first priority, and based on the second data and inaccordance with the second priority.
 23. The system of claim 22, whereinthe medical device is further configured to determine that the firstpriority is higher than the second priority, and in response, performthe operations preferentially in accordance with the first data aspreferred to the second data.
 24. The medical system of claim 21,wherein the first remote device comprises a computing device and atouchscreen.
 25. The medical system of claim 21, wherein the firstremote device comprises a mobile computing device.
 26. The medicalsystem of claim 21, wherein the medical device comprises an interfacewirelessly connected to a remote server.
 27. The medical system of claim21, wherein the first remote device communicates with the medical devicethrough a short-range wireless technology protocol that comprises one ormore of wireless local area network communications or infraredcommunications.
 28. The medical system of claim 21, wherein the displaydevice of the medical device comprises a touchscreen.
 29. The medicalsystem of claim 21, wherein the medical device comprises a dialysismachine.
 30. The medical system of claim 21, wherein the one or moreimages further comprise an image of a user of the medical device. 31.The medical system of claim 30, wherein the medical device furthercomprises a camera, wherein the image of the user is captured by thecamera.
 32. The medical system of claim 21, wherein at least a portionof the user interface of the first remote device displays one or moreimages of a user of the medical device.
 33. The medical system of claim21, wherein the at least a portion of the screen content comprisesvalues representing one or more settings of the medical device.
 34. Themedical system of claim 33, wherein the settings comprise a dialysisfluid flow rate.
 35. The medical system of claim 21, wherein: the screencontent comprises one or more images of a user of the first remotedevice; and the first remote device is further configured to: capture,using a camera of the first remote device, the one or more images of theuser of the first remote device; and transmit, to the medical device,the one or more images of the user of the first remote device fordisplay.
 36. The medical system of claim 21, wherein the first datacomprises the command signals for altering a dialysis fluid flow rate ofthe medical device.
 37. The medical system of claim 21, wherein themedical device is a first medical device, and the system furthercomprises a second medical device, and wherein a treatment state of thefirst medical device is different from a treatment state of the secondmedical device, and wherein a respective treatment state of each of thefirst and the second medical devices indicates a progress of the medicaltreatment that the medical device is currently providing to a patient.38. The medical system of claim 21, wherein the medical device is one ofmultiple medical devices with which the first remote device is incommunication, and wherein a treatment state of the medical deviceindicates that the medical device needs attention, and wherein the firstremote device is further configured to display one or more indicatorsthat point out to the medical device that needs attention such that themedical device is distinguished from other medical devices of themultiple medical devices that do not need attention.
 39. Acomputer-implemented method comprising: determining, by a first deviceremote from a medical device and based on communications between thefirst device and the medical device, a treatment state of a medicaltreatment that the medical device is currently providing; receiving, bythe first device and from the medical device, one or more images of atleast a portion of a screen content presented on a display device of themedical device, the portion of the screen content including an alarmindicator indicating a state of an alarm on the medical device;displaying on a user interface of the first device (i) the one or moreimages of the screen content of the medical device, and (ii) thetreatment state of the medical device, and transmitting, by the firstdevice and to the medical device, first data that influences control ofthe medical device, wherein the first data comprises command signals foraltering the state of the alarm of the medical device and commandsignals for ceasing a dialysis treatment.
 40. The method of claim 39,further comprising: receiving, by the medical device, the first datafrom the first device; receiving, by the medical device and form asecond device, second data that influences the medical device, thesecond device being remote from the medical device; determining a firstpriority assigned to the first device, and a second priority assigned tothe second device; and performing operations based on the first data andin accordance with the first priority, and performing the second data inaccordance with the second priority.